Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (9 études, 2 149 patients), cette méta-analyse compare l'intérêt, du point de vue de données intra- et péri-opératoires (durée de l'opération, perte de sang, nombre de ganglions collectés, durée d'hospitalisation, ...), d'une intervention chirurgicale par voie laparoscopique et d'une chirurgie trans-hiatale pour un adénocarcinome de la jonction
Background : The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Laparoscopic transhiatal approach (LTH) has gained growing popularity in the treatment of AEG. However, its safety and efficacy need to be evaluated. Methods : Original studies comparing LTH with open transhiatal approach (OTH) were searched. Meta-analysis was performed using RevMan 5.3. Results : Nine studies involving 2149 patients were eligible. Compared with OTH, LTH was associated with longer operation time (mean difference [MD] = 31min, 95%CI [20,41], P < 0.001) while less blood loss (MD =
−103ml [-135, −
72], P < 0.001), and harvested similar number of lymph nodes (MD = 0.1 [-1.2, 1.4], P = 0.89). There were no differences in time to ambulation (MD =
−0.79 days [-1.77, 0.20], P
= 0.12) or time to first flatus (MD =
−0.82 days [-1.76, 0.11], P
= 0.08); however, LTH was associated with shorter postoperative hospital stay (MD =
−1.70 days [-2.34, −
1.05], P < 0.001). The mortality after surgery was comparable for LTH and OTH (risk difference [RD] = -0.00 [-0.01, 0.01], P = 0.55). The incidence of total major complications was similar in LTH (6.1%) and OTH (8.4%) (RD =
−0.02 [-0.05, 0.01], P
= 0.12); there were no significant differences in the incidence of each complication. Furthermore, LTH achieved similar 2-year overall survival (OS) rate (risk ratio [RR] = 1.17 [0.86, 1.60], P = 0.31) while higher 5-year OS rate (RR = 1.43 [1.18, 1.73], P = 0.0003) and significant improvement of OS (univariable hazard ratio = 0.65 [0.50, 0.84], P = 0.0009; multivariable hazard ratio = 0.59 [0.44, 0.80], P = 0.0006). Conclusions : LTH is feasible and safe for AEG, and may provide more favorable short-term outcomes and potential long-term survival benefit, which needs to be confirmed by randomized trials.